21 May 2018

Beat the heat!

  • The heat of the sunshine is welcomed by most of us after a hard winter, however high temperatures can be harmful to your health. As we approach the hottest days of the summer as healthcare professionals we need to be aware of those most affected by the heat. 

    Heat can affect anyone, but there are some people who are more vulnerable and at risk than others, including older people, especially those over 75. There are steps you can take to ensure that you look after yourself and those around you.

    Be prepared

    The Met Office issues warnings if a heatwave is predicted, a level 1 alert is usually between the 1st of June and the 15th of September. Keep an eye out for the warnings and alerts from the Met Office.

    Plan ahead to make sure you have enough supplies during a heat wave, such as food, water and medication.

    Know how to cope

    The following steps you can take to ensure that you look after yourself and those who are at risk.

    • Shut windows and pull down the blinds to keep the heat out
    • Have cool baths and showers to bring your body temperature down
    • Drink cold drinks regularly 
    • Avoid excess alcohol and caffeine or drinks with high sugar content as these can dehydrate you
    • Wear loose, cool clothing, if you go outside wear a hat, sunglasses and suncream

    Check on your neighbours

    Friends, relatives and neighbours may be unable to look after themselves during hot weather so check in on them regularly.

    How to identify if someone needs help?

    If you or someone else is feeling unwell the following symptoms may be shown:

    • Breathlessness
    • Chest pain
    • Confusion
    • Intense thirst
    • Weakness
    • Dizziness
    • Cramps 

    In the first instance get the person affected someone cool to rest and give them plenty of fluids to drink. Then seek professional help from either a GP or contact NHS 111. In severe cases ring the emergency services.

15 May 2018

First Aid Skills: Choking

  • If you've ever found yourself choking or seen someone else experiencing it, you'll know it's extremely alarming. Acting swiftly and effectively is essential because this is a potentially life-threatening problem.

    Choking occurs when there's a blockage in the airway.  It's usually caused by food or a swallowed object getting stuck in the throat or trachea and prevents normal breathing.  When administering first aid, the conventional response is to dislodge the blockage using a number of physical techniques. These can seem quite brutal but when someone's choking, you really can't be timid. 

    Banging your hand on the back, between the shoulder blades, is the first intervention to try. However, if this isn't successful, the next step is to undertake 'abdominal thrusts', a technique that was previously referred to as the 'Heimlich Manoeuvre'. It was developed by and is named after the American surgeon Henry Heimlich, MD.

    In the early 1970s, Heimlich noted that food and other objects blocking the airway from the mouth to the lungs were not always expelled by giving sharp blows to the back. In 1974 he devised a new method that he tested on laboratory dogs. It's now almost universally advocated in healthcare training.*

    Apparently, there are photographs available illustrating these experiments but as dog lovers here at Newcross we really couldn't bring ourselves to publish them! But, regardless of the ethical questions about choking and then reviving dogs in the pursuit of medicine, it's fair to say that Heimlich's pioneering work has helped to save many lives.*The techniques outlined in this video are appropriate for most instances of choking and need to be executed in a quick and concerted manner. However, it is important to stress that different techniques should be used for infants and babies. If you're a parent or carer of small people, we recommend undergoing a specialist paediatric first aid course. 

14 May 2018

Remember 'Mother Seacole'

  • A memorial statue stares proudly across the River Thames, dramatically showing this incredible woman's cape caught in the wind, with a backdrop of the Crimean War battlefield. Thanks to the donations of thousands of people this is the UK's first known statue honouring a black woman. Jamaican-born nurse, Mary Seacole was a truly remarkable woman who left her mark on healthcare history.

    Today, on the anniversary of her death, we remember the brave work she carried out at the front line of the Crimean War. In recent years she has been compared to Florence Nightingale, with few people knowing how far she actually went. It can be argued that she went a step further than Nightingale, by riding on horseback into the battlefields!

    1805 - 1881

    Born in 1805 Mary learnt her nursing skills from her Jamaican mother, she traveled to many parts of Central America, the Caribbean and Britain gaining further medical knowledge before asking to be sent to Crimea as an army nurse to join Florence Nightingale and her team of nurses. 

    MS

    Nothing stops her!

    Refused by the War Office this didn't stop Mary! She funded her own trip to Crimea where she established a British Hotel to provide "comfortable quarters for sick and convalescent officers". It is said that she sold everything she had. A hut made out of metal sheets, here soldiers could rest and buy hot food and equipment, Mary used this money to help treat for sick and wounded soldiers. 

    Going a step further

    Not deterred by the battlefield Mary knew that there were soldiers who couldn't get to her British Hotel, so she bravely rode on horseback to the battlefield, even under fire, to help wounded soldiers. Through her incredible care she became known as 'Mother Seacole' - a reputation that could rival Nightingale.

    What we know of Mary comes mainly from her biography, 'the Wonderful Adventures of Mrs. Seacole in Many Lands'. But after her death in 1881 it wasn't until the late 70s that she become widely known. this led to a 12 year campaign to raise over £500,000 to raise a statue to remember her. Remembered for how she broke social rules and prejudices to leave her mark on the world, she put her life on the line to save others. 

    While the achievements of Florence Nightingale cannot be uncredited, these two women become heroes in their own right, both providing unrivalled nursing and saving countless lives throughout the Crimean War. 

14 May 2018

How to relieve stress this Mental Health Awareness Week

  • Stress can be so detrimental to your wellbeing that it can lead to feeling alone and in some cases suicidal, one in six people have self-harmed as a direct result of stress. This Mental Health Awareness Week we take a look at relaxation techniques which help to reduce stress and help to improve your mental and physical health. 

    When you become stressed your nervous system is overwhelmed and 'fight or flight' mode sets in by chemicals that flood your body. This response can be lifesaving in emergency situations, but when it is constantly activated through your every day life you can become worn down. 

    Stress can't always be avoided but you can counteract some of the effects by learning how to relax. Your relaxation response, once activated, will:

    • Slow down your heart rate
    • Slow down your breathing
    • Your blood pressure will drop
    • Muscles relax
    • Blood flow to your brain increases

    The following techniques can help you to activate your relaxation response:

    Mindfulness meditation

    Meditation is just one form of mindfulness, other activities can be applied such as walking, exercising or eating.

    1. Sit on a straight-backed chair or cross-legged on the floor.

    2. Focus on an aspect of your breathing, such as the sensation of air flowing into your nostrils and out of your mouth, or your belly rising and falling.
    3. Once you've narrowed your concentration in this way, begin to widen your focus. Become aware of sounds, sensations, and thoughts.
    4. Embrace and consider each thought or sensation without judging it good or bad. If your mind starts to race, return your focus to your breathing. Then expand your awareness again.

    Deep breathing

    With its focus on full, cleansing breaths, deep breathing is a simple yet powerful relaxation technique. 

    1. Sit comfortably with your back straight. Put one hand on your chest and the other on your stomach.

    2. Breathe in through your nose. The hand on your stomach should rise. The hand on your chest should move very little.
    3. Exhale through your mouth, pushing out as much air as you can while contracting your abdominal muscles. The hand on your stomach should move in as you exhale, but your other hand should move very little.
    4. Continue to breathe in through your nose and out through your mouth. Try to inhale enough so that your lower abdomen rises and falls. Count slowly as you exhale.

    Progressive muscle relaxation

    Progressive muscle relaxation is a two-step process in which you systematically tense and relax different muscle groups in the body. 

    Start at your feet and work your way up to your face, trying to only tense those muscles intended.

    1. Loosen clothing, take off your shoes, and get comfortable.
    2. Take a few minutes to breathe in and out in slow, deep breaths.
    3. When you’re ready, shift your attention to your right foot. Take a moment to focus on the way it feels.
    4. Slowly tense the muscles in your right foot, squeezing as tightly as you can. Hold for a count of 10.
    5. Relax your foot. Focus on the tension flowing away and how your foot feels as it becomes limp and loose.
    6. Stay in this relaxed state for a moment, breathing deeply and slowly.
    7. Shift your attention to your left foot. Follow the same sequence of muscle tension and release.
    8. Move slowly up through your body, contracting and relaxing the different muscle groups.
    9. It may take some practice at first, but try not to tense muscles other than those intended.

    If these relaxation exercises aren't working for you, then try out relaxation or mindfulness apps. There are a wide range of apps in the market, but these top 5 are tried and tested:

    1. Headspace
    2. Calm
    3. Stop, Breathe and Think
    4. Aura
    5. Smiling Mind

    It’s important to remember though that these apps and relaxation techniques are not specifically designed to treat mental health problems, and should not be used as a substitute for seeking professional help should you be suffering from one.

11 May 2018

Let's talk about Mental Health

  • Two thirds of us will experience a mental health problem in our lifetime and stress is a key factor to this. This Mental Health Awareness Week, the Mental Health Foundation and Newcross are asking, are you coping with stress? Stress can affect how you feel, think and behave and how your body works. We share help and guidance to tackling stress. 

    By tackling stress, we can go a long way to tackle mental health problems such as anxiety and depression, and, in some instances, self-harm and suicide. Although there is little you can do to prevent stress, there are many things you can do to manage it more effectively, such as learning how to relax, taking regular exercise and adopting good time management techniques.

    1.       Challenge yourself

    Setting yourself goals and challenges, whether at work or outside, such as learning a new language or a new sport, helps to build confidence. In turn, this will help to alleviate stress.

    2.       Adopt a healthy lifestyle/Be active

    If we eat a healthy diet, exercise regularly and ensure we get adequate sleep and rest, our body is better able to cope with stress should it occur. Exercise causes the body to release endorphins, known to make you feel that much happier.

    3.       Know your limitations and do not take on too much

    We can cause ourselves a great deal of stress because we do not want to let people down. We then end up doing more than we should. Ensure you get a healthy work/life balance by managing your diary effectively and allowing for rest breaks in between periods of working.

    4.       Take control

    Take time to discover the root of your worries and try to change your thoughts and behaviour to reduce it. A stress assessment can help you to fully understand the causes, the implications to your health and how to manage, cope and make necessary changes. The act of taking control is in itself empowering, and it's a crucial part of finding a solution that satisfies you.

    5.       Avoid unnecessary conflict

    Don’t be too argumentative. Ask yourself: Is this really worth the stress? Look for win - win situations. Try and come to a resolution, where both parties can achieve a positive outcome. Find out what the real cause of the problem is and deal with it. Sometimes this means knowing when to apologise and when to let it go.

    6.       Accept the things you cannot change

    Changing a difficult situation is not always possible. If this proves to be the case, recognise and accept things as they are and concentrate on all that you do have control over. Managing change effectively is essential or else performance will be reduced.

    7.       Take time out to relax and recharge your batteries

    Here in the UK, we work the longest hours in Europe, meaning we often don't spend enough time doing things we really enjoy. Make sure you take at least one annual break of at least 10-14 continuous days to ensure you get a healthy work-life balance.

    8.       Connect with people 

    Friends can ease work troubles and help us see things in a different way. The activities we engage in with friends help us relax and we will often have a good laugh. It boosts the immune system that is often depleted during stress. A good support network of colleagues, friends and family can ease your work troubles and help you see things in a different way.

    9.       Try to see things differently: Develop a more positive thinking style

    If something is concerning you, try to see it differently. Talk over your problem with somebody before it gets out of proportion. Overthinking can cause small things to seem far bigger than they actually are. Often, talking to a friend/colleague/family member will help you see things from a different and less stressful perspective.

    10.   Avoid turning to alcohol, nicotine and caffeine as coping mechanisms

    Long term, these faulty coping mechanisms will just add to the problem. For example, caffeine and nicotine are stimulants - too much and the body reacts to this with the stress response increasing or even causing anxiety symptoms.

    For further information and advice:

    Anxiety UK 

    Anxiety UK runs a helpline staffed by volunteers with personal experience of anxiety from 9:30-5:30, Monday to Friday. Call 08444 775 774. 

    Citizens Advice

    Citizens Advice provides free, independent and confidential advice for a range of problems as well as providing information on your rights and responsibilities.

    StepChange

    StepChange provides help and information for people dealing with a range of debt problems. Freephone (including from mobiles) 0800 138 1111.

    Mind Infoline 

    Mind provides information on a range of mental health topics to support people in their own area from 9.00am to 6.00pm, Monday to Friday. Call 0300 123 3393 or email info@mind.org.uk.

    Rethink Advice and Information Service 

    Rethink provide specific solution-based guidance - 0300 5000927 Fax: 020 7820 1149 email advice@rethink.org.

09 May 2018

Celebrating our nurses!

  • This week, International Nurses Day (IND) will be celebrated around the world on the anniversary of Florence Nightingale's birth, the 12th of May, which is the perfect time to mark the contributions that nurses make.

    With the growing strains on the healthcare sector, the role of a nurse is becoming more important than ever, and having strong and resilient health systems in place to effectively respond to challenges and to deliver high quality health care to all is apparent.

    Each year the International Council of Nurses (ICN) draw together essential information on the theme chosen that year. The 2018 IND theme is 'Nurses: A Voice to Lead, Health is a Human Right', the ICN have provided a toolkit which presents compelling evidence showing how investment in nursing leads to economic development; and how improving conditions in which people live leads to cohesive societies and productive economies, which you can find here.

    Being a professional nurse means courage, resilience and trust. It means treating patients and colleagues with dignity, compassion and respect. It also means being accountable and being up to date with best practice and training which is why we are encouraging all of our nurses to take a look at the toolkit.

    "For us who nurse, our nursing is a thing which, unless we are making progress every year, every month, every week, take my word for it, we are going back" Florence Nightingale

    Florence Nightingale [1820-1910]

    On International Nurses Day we also celebrate the founder of modern nursing. Florence went against everything and everyone to fulfil her dream to become a nurse. During the 1800s hospitals were dirty and operations were completed without anaesthetic, most people who went to hospital ended up dying. In 1951 Florence studied to nursing and decided then that it was her calling.

    Florence was asked to lead a team of nurses to support British soldiers in the Crimean War.  But when she arrived the hospital was overcrowded, dirty and patients ate gone off food - nothing was clean.

    “It may seem a strange principle to enunciate as the very first requirement in a hospital that it should do the sick no harm.” 

    Working 20 hours a day, Florence bought fresh food, cleaned kitchens, cleared drains and helped to stop the spread of disease. She became known as the ‘Lady with the Lamp’, as she used to walk around at night to make sure the soldiers were comfortable.

    “She is a "ministering angel" without any exaggeration in these hospitals, and as her slender form glides quietly along each corridor, every poor fellow's face softens with gratitude at the sight of her. When all the medical officers have retired for the night and silence and darkness have settled down upon those miles of prostrate sick, she may be observed alone, with a little lamp in her hand, making her solitary rounds.”

    Welcomed home a hero, Florence’s work throughout the Crimean War transformed modern nursing, improving the quality of care given in war and impacting healthcare practices around the world. This is reflected throughout Newcross, from our nurse-led Complex Care team to our Clinical Governance Nurse Advisors. Expertise and quality at our core.

    On the 14th of May we shall be celebrating the life of another nurse, Mary Seacole, who work tirelessly throughout the Crimean War and who can sometimes be overlooked.

01 May 2018

Sepsis: spot the signs!

  • More people die from sepsis each year than bowel, breast and prostate cancer combined. Also known as blood poisoning, sepsis signs are easily missed, but this potentially life-threatening condition can be treated if caught early.

    Sepsis occurs when chemicals the immune system releases into the bloodstream to fight an infection, cause inflammation throughout the body instead. 

    According to the UK Sepsis Trust, sepsis is the biggest cause of death in UK pregnancies, and 44,000 people in the UK lose their lives to sepsis-related infections each year. Everyone is at risk of developing sepsis, although some people are more vulnerable, such as those who have medical conditions that weaken the immune system, like HIV or leukaemia, the very young or very old and those who are pregnant.

    It is often difficult to diagnose sepsis, as there are many different potential symptoms. However, the most common symptoms recognised in sufferers include: slurred speech or confusion, passing little to no urine in a day, having a fast respiratory rate, having mottled, bluish or discoloured skin and extreme shivering and muscle pain. Not everyone suffering with sepsis will experience all of these symptoms simultaneously.

    Fortunately, there are steps you can take to avoid developing sepsis.

    • First and foremost - get vaccinated.
    • Thirty-five percent of sepsis cases in the 2017 CDC study stemmed from pneumonia.
    • Ensure that any open wounds are cleaned carefully and thoroughly.
    • Treat urinary tract infections promptly. A quarter of recorded sepsis cases are the result of untreated urinary tract infections.
    • Lastly, be vigilant in avoiding infections in hospitals by frequently washing your hands. Whilst sepsis itself is not contagious, the pathogens that may cause sepsis can be passed from person to person via contaminated utensils or clothing.

    But you need to ensure you know the six most common signs of sepsis, they are easy to remember.

    sepsis

    If you are under the impression that you may be affected, seek urgent medical advice. If there is a Newcross healthcare professional to hand, certainly get a second opinion. At Newcross, our nurses and healthcare staff have the clinical expertise to recognise the signs of sepsis. However, if your symptoms are severe, dial 999.

13 April 2018

How does loneliness impact your life?

  • The sad global phenomenon that is loneliness is one that many feel will never pass. It has been proven to impact your mortality rate by nearly 26%! With loneliness prevalent among the older generation, there are almost three quarters of elderly people in the UK failing to tell anyone about how isolated they’re feeling. We take a look at the signs of loneliness and what you can do to prevent it.

    People slip into social isolation for a variety of reasons, such a leaving the workplace, or the death of a spouse or close friend. Our Newcross nurses and healthcare assistants are trained to spot the signs. 

    There are three different types of loneliness:

    1. Situational loneliness, which is associated with environmental factors
    2. Developmental loneliness, which occurs due to factors including poverty, living arrangements, and physical/psychological disabilities
    3. Internal loneliness, which derives from low self-esteem and poor coping strategies
    Loneliness

    How can loneliness impact on a person’s physical health?

    The Journal of Clinical and Diagnostic Research, states that those who are lonely is linked to diabetes, autoimmune disorders like rheumatoid arthritis, lupus and cardiovascular diseases like coronary heart disease. Evidence also suggests that those feeling alone may also suffer with abnormally high blood pressure, by up to fourteen points.

    Loneliness and mental health

    Although loneliness in itself is not a recognised mental health issue. However, the two can in fact, be attributed to one another. It is vital to maintain social relationships in order to satisfy your mental wellbeing. Failing to adhere to our human need for interaction, may lead to psychiatric disorders, such as depression, alcohol abuse and Alzheimer’s disease.

    How to spot loneliness in someone you’re caring for?

    • Drastic changes in their routine e.g. waking up a lot later in the morning.
    • Putting less effort into their physical appearance and/or hygiene.
    • Frequently expressing negative thoughts.
    • Eating considerably less than they usually would.

    Remember also, it is possible to feel lonely whilst surrounded by friends or family.

    So what to do if you’re feeling lonely

    • Give someone a ring.
    • Write upcoming events in a diary on a calendar. This will give you things to look forward to an encourage you to make plans more often.
    • Join a club or find an activity you enjoy doing – this could be at your local community centre, for example.
    • Get to grips with a computer. You can email your relatives or give them a Skype call.
    • However unsure or reluctant you may feel to have a conversation, put yourself out there and you might make a new friend.

    To find out more about differences you can make, visit here for information and advice.

05 April 2018

Stressed Much?

  • Having been recognised in the healthcare world as Stress Awareness Month for the past sixteen years, April is when health professionals unite, in raising awareness about stress and its many causes. The healthcare sector is notoriously demanding, both physically and emotionally. Social Media Champion and Colwyn Bay Healthcare Coordinator, Sian Jones, shares 10 top tips to manage and deal with stress.

    At Newcross, we appreciate the benefits of stress management in the workplace. It highlights the importance of maintaining a happy, healthy workforce. From Branch Managers, to our team of Clinical Nurse Advisors, to Occupational Health, our team have a number of support systems at their disposal.

    A few simple steps can help you to take control of any situation and aid you in reducing your stress. Ignoring stress symptoms will only allow the problem to worsen.

    Stress

     Here are our top ten stress-busting tips:

    1.       Challenge yourself

    Setting yourself goals and challenges, whether at work or outside, such as learning a new language or a new sport, helps to build confidence. In turn, this will help to alleviate stress.

    2.       Adopt a healthy lifestyle/Be active

    If we eat a healthy diet, exercise regularly and ensure we get adequate sleep and rest, our body is better able to cope with stress should it occur. Exercise causes the body to release endorphins, known to make you feel that much happier.

    3.       Know your limitations and do not take on too much

    We can cause ourselves a great deal of stress because we do not want to let people down. We then end up doing more than we should. Ensure you get a healthy work/life balance by managing your diary effectively and allowing for rest breaks in between periods of working.

    4.       Take control

    Take time to discover the root of your worries and try to change your thoughts and behaviour to reduce it. A stress assessment can help you to fully understand the causes, the implications to your health and how to manage, cope and make necessary changes. The act of taking control is in itself empowering, and it's a crucial part of finding a solution that satisfies you.

    5.       Avoid unnecessary conflict

    Don’t be too argumentative. Ask yourself: Is this really worth the stress? Look for win - win situations. Try and come to a resolution, where both parties can achieve a positive outcome. Find out what the real cause of the problem is and deal with it. Sometimes this means knowing when to apologise and when to let it go.

    6.       Accept the things you cannot change

    Changing a difficult situation is not always possible. If this proves to be the case, recognise and accept things as they are and concentrate on all that you do have control over. Managing change effectively is essential or else performance will be reduced.

    7.       Take time out to relax and recharge your batteries

    Here in the UK, we work the longest hours in Europe, meaning we often don't spend enough time doing things we really enjoy. Make sure you take at least one annual break of at least 10-14 continuous days to ensure you get a healthy work-life balance.

    8.       Connect with people Friends can ease work troubles and help us see things in a different way. The activities we engage in with friends help us relax and we will often have a good laugh. It boosts the immune system that is often depleted during stress. A good support network of colleagues, friends and family can ease your work troubles and help you see things in a different way.

    9.       Try to see things differently: Develop a more positive thinking style

    If something is concerning you, try to see it differently. Talk over your problem with somebody before it gets out of proportion. Overthinking can cause small things to seem far bigger than they actually are. Often, talking to a friend/colleague/family member will help you see things from a different and less stressful perspective.

    10.   Avoid turning to alcohol, nicotine and caffeine as coping mechanisms

    Long term, these faulty coping mechanisms will just add to the problem. For example, caffeine and nicotine are stimulants - too much and the body reacts to this with the stress response increasing or even causing anxiety symptoms.

    In order to excel in your work life, you need to reduce your stress levels. By following these helpful steps, you will start to squash any worries or strain you may be experiencing.  Nothing should come before your mental health and wellbeing.

04 April 2018

Not documented? Not done.

  • There is a lot of information about good documentation in nursing. Whilst it is often related to the legal importance of accurate record keeping, it is essential to remember that documentation is also a good way of communicating with your colleagues. Further still, it can contribute to the assessment of care and decisions made about ongoing care, as well as treatment for the service user.

    The NMC code states that clear accurate record keeping is an obligation of any nurse and as such, should be considered as an important part of the care we give to our service users.

    There are few standardisations of documentation models and, therefore, when working in different areas of care, it is vital to be aware of local policies relating to documentation. As we move further into the electronic age, an understanding of the systems used in the area in which you are working is paramount for accurate and consistent documentation to be maintained.

    Whatever system you are using, there are clear rules you must follow, to ensure that your documentation is accessible. It is important that others can understand what you have recorded, and what that means for the service user you have been caring for.

    NMC code:

    Good record keeping is an integral part of nursing and midwifery practice, and is essential to the provision of safe and effective care. It is not an optional extra to be fitted in if circumstances allow (NMC 2009)

    Keep clear and accurate records relevant to your practice (NMC Code 2015)

    This includes but is not limited to patient records. It includes all records that are relevant to your scope of practice. To achieve this, you must:

    • Complete all records at the time or as soon as possible after an event, recording if the notes are written sometime after the event.
    • Identify any risks or problems that have arisen and the steps taken to deal with them, so that colleagues who use the records have all the information they need.
    • Complete all records accurately and without any falsification, taking immediate and appropriate action if you become aware that someone has not kept to these requirements.
    • Attribute any entries you make in any paper or electronic records to yourself, making sure they are clearly written, dated and timed, and do not include unnecessary abbreviations, jargon or speculation.
    • Take all steps to make sure that all records are kept securely.
    • Collect, treat and store all data and research findings appropriately.

    The NMC refers to many types of records - not just the services user’s notes. It is important that we use many forms of record keeping and these can include e mails, incident reports, videos, photographs, text messages and tape recordings of telephone conversations.

    Golden rules:

    • Legible hand writing.
    • Be objective.
    • Be factual consistent and accurate.
    • Avoid gaps in medical records.
    • Avoid Jargon and abbreviations.
    • Document time and date clearly.
    • Document as close as possible to time of event or care given.
    • Focus on facts not speculation.
    • Do not change or alter others documentation if you need to amend your writing draw a clear line through it and sign and date any changes.
    • Date and sign all entries.
    • Records should follow a logical sequence allowing those caring for the patient after you to be clear of care given and care required.
    • Document things not done with clear rational especially if it is deviates from an agreed plan.

    Countersigning:

    Registered nurses can delegate record-keeping to care assistants, assistant practitioners and nursing students. Whilst, they can document their care, a countersignature is required until the member of staff is deemed competent. However, a registered nurse should not countersign if they have not witnessed the activity. All nurses should be aware of local policy with regards to countersigning documentation (RCN 2017)

    Care plans should be written wherever possible with the involvement of the service user, in terms that they can understand, and include:

    • Patient-focused, measurable, realistic and achievable goals
    • Nursing interventions reflecting best practice
    • Relevant core care plans that are individualised, signed, dated and timed. (Marsden 2015)

    Tips for evaluating care in a useful and meaningful way

    • Appears comfortable – slept well
      • Try to identify this using the person’s perspective i.e. what the patient states Patient states’ Pain was better so had a good night’s sleep’
    • No problems with wound
      • Be specific -Size of wound noted, any inflammation noted any dressings any diagrams attached.
    • Patient fell
      • Be specific – Was it witnessed? What did the person say happened? What were your actions – Has care changed following fall.
    • Very confused
      • Be specific i.e. confused in time, place and person what behaviour was the person showing to make you conclude they were confused.
    • Uncooperative
      • ​​​​​​​Be specific – How were they uncooperative Were they verbally uncooperative what behaviour were they displaying i.e. shouting or swearing when you were trying to help.
    • Dizzy at times
      • ​​​​​​​Give more detail when did they state they were dizzy were observations recorded what follow up is planned? I.e. doctor informed for review tomorrow.

    The Royal Marsden Manual of Clinical Nursing Procedures: , Ninth Edition Chapter Two ‘Assessment and Discharge’ Edited by Lisa Dougherty, Sara Lister and Alexandra West-Oram

    © 2015 The Royal Marsden NHS Foundation Trust. Published 2015 by John Wiley & Sons, Ltd.

    www.nmc-uk.org/code accessed March 2017

    RCN 2017 Delegating record keeping and countersigning records 3rd edition Publication code 006 134